Causes and costs of injuries in multiple trauma patients requiring extrication from motor vehicle crashes

Siegel, John H.; Mason-Gonzalez, Stephanie; Dischinger, Patricia C.; Read, M.; Cushing, Brad M.; Badellino, Michael C.; Goodarzi, Shirin; Smialek, John E.; Heatfield, Barry M.; Robinson, Richard M.; Parkinson, Karen; Hill, Wendy J.; Jackson, Jerry W.; Livingston, D. J.; Bents, Frances D; Clark, Carl C.

Affiliations

¹Anatomy, Cell Biology, and Injury Sciences, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark

²Maryland Institute for Emergency Medical Services Systems, University of Maryland, Baltimore, Maryland

³Medical Examiners' Office, State of Maryland

⁴Dynamic Science, Inc., Annapolis, Maryland

Abstract

Prospective and contemporaneous medical and economic cost studies of 144 victims of motor vehicle crashes admitted to a regional level trauma center with multiple injuries (ISS ≥ 16) revealed 122 non-ejected patients, of whom 102 required extrication (EXTRIC) from the vehicle for physical of medical reasons and 20 who did not (N group). There were no differences in age (EXTRIC, 34 ± 17 years; N, 41 ± 24 years), type of crash (Frontal: 57% EXTRIC, 60% N; Lateral: 32% EXTRIC, 35% N) restraint use (35% EXTRIC, 35% N), or mortality (29% EXTRIC, 30% N). However, the estimated maximum speed before the crash was higher in EXTRIC patients (50 ± 16 mph vs. 46 ± 18 mph N, p < 0.04), as was the change in velocity (ΔV) on impact (EXTRIC 30 ± 15 mph; N, 24 ± 8 mph, p < 0.01). Brain injuries (51% EXTRIC vs. 35% N) and lower extremity injuries were more numerous in EXTRIC patients (59% vs. 20% N, p < 0.003) and the number of splenic, lower extremity, and pelvic injuries associated with shock was greater in EXTRIC patients, p < 0.02; as were postinjury complications. As a result, operating room costs from orthopedic and plastic surgery increased professional charges in the EXTRIC group versus the N group ($20,000, EXTRIC; $17,000, N) and critical care costs ($13,000, EXTRIC; $4,000, N) with total costs of $72,000 and $77,000, respectively. The lower extremity injuries in EXTRIC patients were primarily a result of body part contacts with intrusions (Cls) of the car occupant compartment structures (73% wirth vs. 24% without (p < 0.0001)]. In lateral MVCs, brain injuries were also more commonly associated with Cls of the side window trame or A pillar (72% Cl ys 25% no Cl; p < 0.035); but as a whole in MVCs in which extrication was necessary, lower extremity injuries from instrument panel or toepan Cls appeared more frequent than those resulting from contacts only (p < 0.0001). In EXTRIC patients, 69% of those in shock had Cl injuries, and 80% of the deaths in the EXTRIC group were associated with Cl injury. These data suggest that measures designed to prevent Cls by strengthening car passenger compartment structures may reduce the incidence of severe brain and lower extremity injuries and may reduce the need for extrication after MVCs.

Links

DOI: 10.1097/00005373-199312000-00019

PubMed: 8263992

WoS: A1993MP51800019

Ovid: 00005373-199312000-00019

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Year	Entry
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Cited By (11)

Year	Entry
1994	Dischinger PC, Burgess AR, Cushing BM, Pilkey WD, Crandall JR, Sieveka EM, Klopp GS. Lower extremity trauma in vehicular front-seat occupants. In: Proceedings of the 4th Injury Prevention Through Biomechanics Symposium. May 1994; Detroit, MI.
1994	Dischinger PC, Kerns TJ, Kufera JA. Lower extremity fractures in motor vehicle collisions: the role of driver gender and height. In: 38th Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). September 21-23, 1994; Lyon, France.335-342.
1995	Dischinger PC, Siegel JH, Ho SM, Kufera JA. The effect of impact velocity (delta V) on development of injury complications in multiple trauma motor vehicle crash patients. In: 39th Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). October 16-18, 1995; Chicago, IL.367-379.
2002	Read KM, Burgess AR, Dischinger PC, Kufera JA, Kerns TJ, Ho SM, Burch C. Psychosocial and physical factors associated with lower extremity injury. In: 46th Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). September 30–October 2, 2002; Tempe, AZ.
2003	Pintar FA, Olshanski J, Yoganandan N. Vehicle incompatibility affects occupant extrication after motor vehicle crashes. In: Proceedings of the 18th International Technical Conference on the Enhanced Safety of Vehicles (ESV). May 19-22, 2003; Nagoya, Japan.
2005	Scarboro M, McCullough C, Sarda P. Crash injuries and long-term consequences: the CIREN experience. In: Proceedings of the 19th International Technical Conference on the Enhanced Safety of Vehicles (ESV). June 6-9, 2005; Washington, DC.
2009	Malczyk A, Mayr E, Ecker M, Seebauer T, Weber C, Lampl L, Helm M, Kulla M, Winkler L, Gebhard F, Liener U. Car crashes with polytrauma in southern Germany. In: Proceedings of the 21st International Technical Conference on the Enhanced Safety of Vehicles (ESV). June 15-18, 2009; Stuttgart, Germany.
1996	Dischinger PC, Ho SM, Kerns TJ, Brennan P. Patterns of injury in frontal collisions with and without airbags. In: Proceedings of the 1996 International IRCOBI Conference on the Biomechanics of Impact. September 11-13, 1996; Dublin, Ireland.311-319.
1995	Dischinger PC, Kerns TJ, Kufera JA. Lower extremity fractures in motor vehicle collisions: the role of driver gender and height. Accid Anal Prev. August 1995;27(4):601-606.
1995	Burgess AR, Dischinger PC, O'Quinn TD, Schmidhauser CB. Lower extremity injuries in drivers of airbag-equipped automobiles: clinical and crash reconstruction correlations. J Trauma. April 1995;38(4):509-516.
2004	Read KM, Kufera JA, Dischinger PC, Kerns TJ, Ho SM, Burgess AR, Burch CA. Life-altering outcomes after lower extremity injury sustained in motor vehicle crashes. J Trauma. October 2004;57(4):815-823.